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Common travel diseases. Minus malaria and dengue. Guess that disease!. Patient presents with abdominal pain and a fever. Patient is a sheep farmer. O/E – hepatomegaly , jaundice. Remembering Murphy’s punch test wrong, you decide to punch the liver. Why is this a horrendous idea?.

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common travel diseases

Common travel diseases

Minus malaria and dengue

slide3

Patient presents with abdominal pain and a fever.

  • Patient is a sheep farmer.
  • O/E – hepatomegaly, jaundice.
  • Remembering Murphy’s punch test wrong, you decide to punch the liver.
  • Why is this a horrendous idea?
slide5

Patient complains of fever. .

  • As well as these little things.
  • Diarrhoea – blood, mucus.
  • Urination is now painful and is a strange colour.
  • Recently been swimming in malawi.
  • Diagnosis – eggs in urine or faeces
  • Mangement – praziquantel, molluscides
slide7

Patient comes in with an ulcer on his foot.

  • What else may they have?
  • Splenomegaly, pancytopenia. Why?
slide9

Epidemiology

    • Affects 3-5 million per year, 100,000-130,000 deaths, mainly developing world
  • Symptoms
    • Asymptomatic, severe diarrhoea with rice water stools (watery flecks of mucus), no blood, vomiting, abdominal cramping
  • Pathogenesis
      • Attaches and colonises small intestine – releases a toxin which leads to increased chloride secretion and decreased sodium absorption
  • Prevention
    • Antibiotic prophylaxis, vaccine (only some strains)
  • Treatment
    • Fluid management, antimicrobidal therapy, zinc supplemenation
  • Disease
    • Cholera
slide10

Epidemiology

    • Africa, South America, Asia
    • 16-33 mill per year, 216,000 deaths
  • Symptoms
    • Encephalitic – hydrophobia, aerophobia, pharyndeal spasms, hyperactivity
    • Paralytic – quadriparesis, sphincter involvement, cerebral involvement late
    • Non-classical – neuropathic pain, motor/sensory deficits, choreiform movements, cranial nerve palsies etc..
  • Pathogenesis
      • Virus deposited in wound, travels form the periphery to the dorsal root ganglia then to the brain.
      • Prefentially localise in the brain stem, thalamus, basal ganglia, spinal cord, then from neural pathways to other organs
  • Prevention
    • Don’t get bitten, pre-exposure prohphylaxis, post-exposure prophylaxis
  • Treatment
    • With one exception, no patient who has been exposed and has not been vaccinated has survived.
    • Incubation period ranges several days to a year
  • Disease
    • Rabies
slide11

Epidemiology

    • Equatorial Africa, northern parts of South America
  • Symptoms
    • Subclinical
    • Abortive, nonspecific febrile illness without jaundice
    • Fever, jaundice, renal failure, hemorrhage
  • Pathogenesis
      • Single stranded RNA virus, transferred via mosquito.
      • Replication begins at site of innoculation spreads through lymphatics – monocytes, macrophages preferred.
      • Liver – Councilman bodies, apoptosis – midzone of liver
      • Renal – eosinophilic degeneration, fatty change of renal tubular epithelium without inflammation
      • Late phase – circulatory shock – cytokine dysregulation
      • Symptoms 3-6 days after bite
  • Prevention
    • Vaccination (not < 9 months), don’t get bitten
  • Treatment
    • No specific anti-viral. Symptomatic treatment.
  • Disease
    • Yellow fever
slide12

Epidemiology

    • Mexico, Nepal, Indian, Pakistan, South-East Asia, Latin America, Middle East, Central Africa
  • Symptoms
    • Abdominal cramps, frequent diarrhoea with loose, watery bowel motions, possible vomiting
  • Pathogenesis
      • Shigella, campylobater, Ecoli, salmonella infection
      • Usually mild, lasts 2 to 3 days. Rare for over 5 days.
  • Prevention
    • If you can’t peel it, boil it or cook it don’t eat it.
  • Treatment
    • Hydration, antimotility agents, antibiotic, hospital
  • Disease
    • Traveller’s diarrhoea
slide13

Epidemiology

    • Especially – Nepal, Mongolia, Vietnam, parts of Africa and Asia
  • Symptoms
    • Fever, neck stiffness, altered mental status, rash
  • Pathogenesis
      • Sepsis – meininges is first, infected fluid then passes into the spinal cord causing the other systems
  • Prevention
    • Antimicrobial prophylaxis,
  • Treatment
    • Appropriate antibiotic, shock management, glucocorticoids, sepsis treatment
  • Disease
    • Meningococcal infection
slide14

Epidemiology

    • Africa, South America, Asia
    • 16-33 mill per year, 216,000 deaths
  • Symptoms
    • Abdominal pain, fever, chills, constitutional symptoms, hepatosplenomegaly
  • Pathogenesis
      • Salmonella typhi (only human reservoir)
      • In small intestines access submucoa via M-cell, or direct penetration into the epithelial cel
      • Proliferate – hyertrophy, immune response, later on necrosis. Able to spread via blood and lymphatics
      • Eventually resides in monocyte or tissue macrophages in liver, spleen, bone marrow
  • Prevention
    • Vaccine
  • Treatment
    • Fluid management, antimicrobidal therapy
  • Disease
    • Typhoid
slide15

Epidemiology

    • Asia
    • 50,000 cases per year
  • Symptoms
    • Acute encephalitis (headache, fever, confusion ,drowsiness, fatigue)
    • Fever, diarrhoea, rigors, headahce, vomitng, weakness, mental status changes, neurological defects
  • Pathogenesis
      • Enzootic cycle, mosquitos, pigs, wading birds
      • That is all I got…
  • Prevention
    • Vaccine
  • Treatment
    • Control ICP, maintenance of cerebral perfusion seizure control, no good anti-viral agent
  • Disease
    • Japanese B encephalitis
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